The absence of a trauma system in our setting meant that there was no prehospital care. It is therefore reasonable GDC-0994 order to expect that preventable deaths must have occurred in the field. Chances of survival following injuries depend on how fast the patient can be evacuated to a facility that is able to provide treatment for their injuries. Movement in the field was hazardous for victims, medical personnel and even the military. For this reason, it was extremely difficult to mobilize staff to the hospital to relieve those that were over-worked; in any case, it was not possible for staff that had been at work for several hours at a stretch to go home for the

same reason. Some personnel were on ground for 72 to 96 hours without relief. Evacuation of the casualties was left mainly to security personnel. Non military personnel who carried out rescue did so at great personal risk. Some buy BX-795 medical personnel who braved the streets

were attacked, and when a 24 hour curfew was imposed on the city and its environs, such attacks were as likely to come from military personnel enforcing the curfew as they were to come from rioting Selleckchem Dinaciclib civilians breaking it. There was a lag in the take off of the hospital response, due to lack of prior warning. Once it started however, it was efficient in the first 24 to 48 hours. Subsequently supplies began to run out with a resultant dip in the standard of care. Intravenous fluids, dressing material, splints, essential drugs, sterile instruments and blood soon ran out. We noted particularly that patients requiring large volumes of blood transfusion for resuscitation in the ER often depleted the blood bank reserves without surviving, in the process putting a

huge strain on the availability of the product for those that required it for surgical operations. This explains why some protocols urge that serious consideration be given to avoiding blood transfusion in such situations [9]. Supplies had been mobilized from other parts of the hospital as the ER reserves ran low, but it was not possible to replenish these sources Metalloexopeptidase as they became exhausted. Even when certain supplies were available in the main hospital store, the myriad of challenges made their availability impossible. For example, while the ER and wards had run out of supplies of sterile dressing materials, the main hospital store had enough stock to last 90 days. These were not available however because the head of stores who had access and authority to release them was not on the premises. Communicating with him was a challenge. When contact was established, he could not come because of the violence in his neighborhood. There was a pool of duty vehicles to convey him, but most drivers were not on the premises and couldn’t come in either. When a driver was mobilized, he required security personnel for protection.